I was contacted by Patricia O'Grady and asked to do an interview about the technical considerations involved with tattoos, mastectomies, and breast reconstruction. The following is my contribution to her book, which can be purchased from Amazon.com.

Interview with Pat Fish - Tattoo artist

I had the pleasure of interviewing a delightful tattoo artist from Santa Barbara, California, Pat Fish

When Pat Fish was a child, she had no ethnic identity. As an orphan, she felt alone and yearned for a connection to a bloodline. She finally met her true Pictish Scottish relatives and learned of her heritage right around the time that she began tattooing, a lattice of coincidence that told her she was meant to do Celtic tattoos.

She has made many pilgrimages to Celtic lands and researched ancient illuminated manuscripts, tramped through muddy fields to see standing stones and Neolithic monuments, and spent many an hour in deserted graveyards with charcoal and paper, taking rubbings from high crosses.

Pat is a gifted artist, blessed with a kind of dyslexia that allows her to be ambidextrous and see things backwards and forwards with ease, so looking at the negative spaces and interlacings in Celtic weaves is something she has found to be endlessly fascinating.

In her own words: "In the past several years I have had the opportunity to meet and work with some outstanding people whose lives have been forever shaped by their encounters with the disease of breast cancer. I truly believe that the way to live a fulfilled and satisfying life is to follow what you love, and let that interior gyroscope lead you to the things that make you happy. Tattooing allows me to be an agent of completion, a person who helps others to achieve a goal of wearing art on their bodies, in their skin, that can never be taken from them. For every person, there should be passions, enthusiasms, even obsessions, that can rightly give a clue as to what their appropriate tattoo should be. It is never for me to say what image a person should choose; your body is a temple and I'm just there to paint the walls. Every woman is unique, with her own special beauty. A tattoo can celebrate this with permanent jewelry that can never be lost or stolen. It is a wonderful life I have chosen. There have been many challenges and opportunities that I have been grateful for, fascinating clients and amazingly talented peers."

O'Grady: I think your work is absolutely beautiful.

Fish: Thanks so much for saying so.

O'Grady: Right now, I'm a tattoo virgin.

Fish: I prefer to think of you as being a blank.

O'Grady: My doctor wants me to wait a year before having any tattooing done to my breasts.

Fish: That is very sensible; the doctor is the best judge of the strength of the skin tissue and of your immune system.

O'Grady: How long have you been working as a tattoo artist?

Fish: I began in 1984, after careers in journalism, illustration and market research. I wanted to do art full time, and I wanted to have close contact with the people who would be commissioning my artistic skills.

O'Grady: Do you do realistic nipple tattoos on reconstructed breasts?

Fish: No, I am not capable of that illusion. I do art, so the women I work with are looking to have their scars mitigated and transformed into something beautiful, not an approximation of their former anatomy.

O'Grady: How many tattoos have you done on women who have had breast reconstruction due to cancer?

Fish: About a dozen.

O'Grady: Is it harder to tattoo on a woman who had made the decision not to do reconstruction because she is down to the bone?

Fish: No, the tattooing process is very shallow, no deeper than the width of a dime, so the issue is the nerves and where they may be. With anyone whose anatomy has been shifted surgically, there are phantom pains and unexpected sensitivities where the nerves have regrown.

O'Grady: While a tattoo cannot eradicate a scar or the skin's texture, it does seem to hide it very effectively. Is it more challenging for you as an artist to tattoo over a scar?

Fish: The scar tissue is not as strong as normal skin, and so requires an adapted technique. If normal tattooing is done, it can chew up the skin and the ink will be forced out in the resultant scabbing. So we have specific ways of using a pointillist technique to build up the tattoo on top of the scar tissue. This way, there are fewer holes poked into the area, and it has a better chance of healing and retaining the ink.

O'Grady: Does the skin hold the ink differently due to the thickness of the scar tissue?

Fish: Not the thickness, per se, but the composition of the collagen in the tissue is very different, and regeneration of the skin is impeded, so when you place foreign material into it, the possibility is that it will over-react and try to force the irritant out. In this case, that would mean the tattoo ink would scab up with lymph and then peel away, leaving only part of it in the skin.

O'Grady: Have you seen any problems with infections or inflammation from tattooing over scars?

Fish: No, tattooing is fairly simple and, with minimal care, they heal well. An allergic reaction to the ink or suspension agents is always possible with someone who has a suppressed immune system, so waiting until all medical treatments are completed is always advisable.

O'Grady: It is no secret that getting a tattoo has some degree of pain involved. In your experience of doing tattoos, do you think it's more or less painful to get a tattoo over these kinds of scars?

Fish: More painful, but worth it. For a woman to have undergone a medical course of treatment so severe, only to be left with a patchwork of scars, can make it hard for her to focus on the positive and remember that the scars represent survival. Artistic tattoos can be transformative and freeing, making beauty and camouflaging the painful memory.

O'Grady: Do you ever use any kind of numbing medication on the area to be tattooed? If so, does this have any negative effect on the final outcome of a tattoo?

Fish: I do not. I know many artists do, but in my experience, they made the skin rubbery and difficult to work with, to the point that I had to go over much of the work a second time. I think that the pain is a transformative process, and bearing it for the desired result is part of the price you pay.

O'Grady: I have always felt that women can endure more pain than men; would you agree with that?

Fish: Women tend to acknowledge that the pain is happening, and then steel themselves to endure it for the sake of the beauty to follow. In our culture, women learn young that sometimes transformative processes thought to give greater physical attractiveness require painful resignation. Men, on the other hand, have been taught not to acknowledge pain, and so will try to tough it out and so end up making it harder on themselves.

O'Grady: I feel that by producing a piece of beautiful artwork to disguise these scars, it is possible for a woman to gain the sense of reclaiming her body, and regain self-confidence. Do you notice a visible change in these women when their tattoo has been completed?

Fish: I have had phone calls from family members thanking me, telling me that the change in their loved one is remarkable. The women themselves will tell me that after having been submissive and cooperative through all of the medical tortures, and having completed the course of treatment, the tattoos I have done for them are a statement that their body is once again their own. And once again a thing of beauty in their eyes.

O'Grady: I know that you truly specialize in Celtic design tattooing, and I would think that the intricate patterns would work well to cover up scars.

Fish: It is actually difficult to conform a Celtic design to the body, and if there are scars, it is necessary to adapt the pattern so that if there is ink rejected by the body, it has minimal visibility within the pattern. I do all sorts of tattooing; my particular love is Celtic and Pictish work, but I am very happy reproducing botanical prints and any precisely rendered archival material.

O'Grady: Many women want to feel as feminine as possible after losing their breasts and desire girly-girl tattoos, which usually consist of pinks and pastel colors, flowers and such. Are certain color inks better than others for this kind of scar cover-up tattoo?

Fish: Sensitivity to the different contents of tattoo inks is usually not an issue, but with someone whose immune system has undergone chemotherapy or radiation, it is possible that they might have a reaction to red pigment, which is included in pinks and purples and lavenders. If there is any question, a tattoo should be begun with only the black ink, because carbon is the most neutral. If they heal it well, then add in the blues, and work up through the color spectrum. It is extremely rare for anyone to have a reaction to a tattoo if they are in good health and use proper aftercare, but with someone with a suppressed immune system, care and caution is wise.

This ended my contribution to the book.

I hope this has made interesting reading, and may help women who have had breast cancer to consider tattooing as an option. Please contact me if you wish to explore working with me for such a transformation. And consider purchasing this book if you or someone you love is facing breast cancer treatment. It will give much information that may be helpful and comforting.